Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism

Gómez-Ramírez, Joaquín; Sancho-Insenser, Joan; Pereira, José António; Jimeno, Jaime; Munné, Assumpta; Sitges‐Serra, Antonio

doi:10.1007/s00423-010-0680-8

Cited by 24 publications

(15 citation statements)

References 14 publications

(11 reference statements)

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“…This is considerably lower than reported in first-time surgery, reflecting that this patient subgroup is more likely to have multigland disease, smaller volume disease or concurrent thyroid disease, which are all known to lower the efficacy of localisation studies. [11][12][13][14] Over a quarter (28%) of the patients in our series had concurrent thyroid disease. 4D CT is currently the second-line investigation for patients with negative conventional parathyroid imaging.…”

Section: Discussionmentioning

confidence: 81%

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

McIntyre

Allen

Constantinides

et al. 2015

annals

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INTRODUCTIONReoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, 'persistent disease' is defined as the situation where the patient has not been cured by the first operation. The term 'recurrent hyperparathyroidism' is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence. METHODS Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation. RESULTS Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease. CONCLUSIONS Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate. Primary hyperparathyroidism (HPT) is caused by a single adenoma in approximately 90%, multigland disease including adenomas or hyperplasia in 10% and parathyroid carcinoma in under 1% of cases.1 Parathyroidectomy remains the definitive cure of primary HPT and the procedure of choice in refractory tertiary HPT in renal failure patients both before and after renal transplantation. Failure to cure HPT at the first operation (persistent HPT) is reported to occur in 5% of cases, both in the literature and in national registry data, but this is very probably underreported.2,3 In contrast, patients with recurrent HPT will have been biochemically cured (normal serum calcium and accommodated parathyroid hormone) for more than six months since the initial operation.Patients who have ongoing HPT despite a previous operation are candidates for a reoperative parathyroidectomy. This surgery is associated with higher rates of postoperative complications as well as a lower chance of being cured. 4,5 The aim of our study was to review our departmental experience of reoperative parathyroidectomy with a view to identifying patterns of disease persistence and recurrence.

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Section: Discussionmentioning

confidence: 81%

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

McIntyre

Allen

Constantinides

et al. 2015

annals

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“…Thirteen studies were prospective [10][11][12][16][17][18][19][20][21][22][23][24][25] and 15 were retrospective. 4,5,[26][27][28][29][30][31][32][33][34][35][36][37][38] Levels of evidence analysis were determined to be level III (cohort studies) and V (case series). The main concerns regarding study quality were: minor variations in patient inclusion criteria, potential bias in patient selection inherent to retrospective studies, and heterogeneity in the reporting of data and summary statistics.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…4,5,[10][11][12]17,19,20,22,23,30,31 Dual-phase 99m Tc-sestamibi (MIBI) was assessed in 13 studies. 4,10,11,[19][20][21]24,[28][29][30]32,37,38 Based on 11 studies, 4,10,11,19,20,22,24,28,31,32,38 MIBI had a pooled sensitivity of 0.76 (95% CI 0.71-0.80) and PPV of 0.86 (95% CI 0.82-0.90). Interestingly, some of these studies (n 5 10) also included comparative cohorts without concurrent thyroid pathology showing sensitivity of MIBI ranging from 0.63 to 1.00 and PPV from 0.92 to 1.00.…”

Section: Imaging Modalitiesmentioning

confidence: 99%

Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

et al. 2018

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“…21,22 The Tc-MIBI scan is not specific for parathyroid tissue, and thyroid nodules also accumulate Tc-MIBI. 23 In selected cases with a single adenoma and a positive scan and, if possible, without thyroid nodular disease, this new device may replace the intraoperative measurement of iPTH. However, in unselected cases, in conjunction with radio-guided surgery, the intraoperative iPTH assay is considered to be an important tool in surgery for PHPT.…”

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confidence: 99%

Could the eZ-SCOPE AN Gamma Camera Replace Intraoperative Measurement of iPTH for PHPT?

Fujii

Yajima

Yamaguchi

et al. 2012

International Surgery

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Intraoperative intact parathyroid hormone (iPTH) measurements have been proposed as an effective assay in surgery for primary hyperparathyroidism (PHPT). We have demonstrated the efficiency of the use of a hand-held gamma camera, eZ-SCOPE AN, with technetium-99m sestamibi (Tc-MIBI) scintigraphy for navigation surgery for PHPT. The aim of this preliminary study was to assess the possibility that the eZ-SCOPE AN can replace the measurement of intraoperative iPTH in surgery for PHPT. Sixteen consecutive patients with documented primary hyperparathyroidism underwent surgery using this compact camera. iPTH was routinely measured preoperatively and 10 minutes after the complete removal of adenoma. All patients had a well-defined parathyroid lesion identified on preoperative Tc-MIBI. The eZ-SCOPE revealed hyperfunctioning parathyroid glands in all cases. iPTH levels were decreased in all cases after the removal of adenomas. Our results suggest that this gamma camera is useful for confirming complete resection of endocrinologically active tissue in surgery for PHPT. In selective patients with scan-positive cases identified by preoperative Tc-MIBI, the eZ-SCOPE may replace the intraoperative iPTH assay in surgery for PHPT.Key words: Primary hyperparathyroidism -Navigation surgery -Gamma cameraSestamibi scintigraphy -Intact PTH On the other hand, technetium-99m sestamibi (Tc-MIBI) scintigraphy is a useful preoperative diagnostic tool in PHPT. 9,10 There have been some reports of radio-guided surgery for PHPT. [11][12][13][14][15][16][17][18] We have recently demonstrated that in scan-positive cases identified by preoperative Tc-MIBI, Tc-MIBI scintigraphy with the use of a hand-held gamma camera, the eZ-SCOPE AN, is useful for navigation surgery for PHPT and minimally invasive parathyroidectomy. 18 The eZ-SCOPE AN is designed to be used as a hand-held, regional diagnostic imaging device, which is a new compact-type semiconductor gamma camera based on the use of a cadmium-zinctelluride (CdZnTe) detector. [18][19][20] In the current preliminary study, we assessed the possibility of using the eZ-SCOPE AN in surgery to replace the measurement of intraoperative iPTH for PHPT. Patients and MethodsSixteen consecutive patients with documented PHPT who underwent surgery by the same surgical team in the Department of General Surgical Science, Graduate School of Medicine, Gunma University, from May 2006 to April 2011, were enrolled in this study. The patients with clinical and laboratory findings of PHPT were evaluated by Tc-MIBI scintigraphy and neck ultrasound and computed tomography (CT). Suspected multigland disease or negative scintigraphy cases were excluded from this study. The diagnosis of PHPT was based on hypercalcemia documented on at least two occasions and an elevated iPTH level. All the patients included in this study gave their informed consent, and the research project was authorized by the Committee for Ethical Research of the Graduate School of Medicine, Gunma University.The eZ-SCOPE is designed to be used as a hand...

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Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism

Abstract: In patients with coexisting thyroid disease but not thyroidectomy needed, MIBI scintigraphy contributes to the detection of a solitary adenoma. When thyroid resection is required, MIBI imaging is often negative.

Cited by 24 publications

References 14 publications

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

Could the eZ-SCOPE AN Gamma Camera Replace Intraoperative Measurement of iPTH for PHPT?

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